Waltenberger Maria, Strick Christian, Vogel Marco M E, Diehl Christian, Combs Stephanie E
Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany.
German Cancer Consortium (DKTK), Partner Site Munich, a Partnership between DKFZ and University Hospital Klinikum Rechts der Isar, 81675 Munich, Germany.
Cancers (Basel). 2023 Dec 12;15(24):5813. doi: 10.3390/cancers15245813.
(1) Purpose: To assess the safety and effectivity of stereotactic body radiotherapy (SBRT) on spinal metastases utilizing a simultaneous integrated boost (SIB) concept in oligometastatic cancer patients. (2) Methods: 62 consecutive patients with 71 spinal metastases received SIB-SBRT between 01/2013 and 09/2022 at our institution. We retrospectively analyzed toxicity, local tumor control (LC), and progression-free (PFS) and overall survival (OS) following SIB-SBRT and assessed possible influencing factors (Kaplan-Meier estimator, log-rank test and Cox proportional-hazards model). (3) Results: SIB-SBRT was delivered in five fractions, mostly with 25/40 Gy ( = 43; 60.56%) and 25/35 Gy ( = 19, 26.76%). Estimated rates of freedom from VCF were 96.1/90.4% at one/two years. VCF development was significantly associated with osteoporosis ( < 0.001). No ≥ grade III acute and one grade III late toxicity (VCF) were observed. Estimated LC rates at one/two years were 98.6/96.4%, and histology was significantly associated with local treatment failure ( = 0.039). Median PFS/OS was 10 months (95% CI 6.01-13.99)/not reached. Development of metastases ≥ one year after initial diagnosis and Karnofsky Performance Score ≥ 90% were predictors for superior PFS ( = 0.038) and OS ( = 0.012), respectively. (4) Conclusion: Spinal SIB-SBRT yields low toxicity and excellent LC. It may be utilized in selected oligometastatic patients to improve prognosis. To the best of our knowledge, we provide the first clinical data on the toxicity and effectivity of SIB-SBRT in spinal metastases in a larger patient cohort.
(1) 目的：评估立体定向体部放疗（SBRT）采用同步整合加量（SIB）概念治疗寡转移癌患者脊柱转移瘤的安全性和有效性。(2) 方法：2013年1月至2022年9月期间，我院连续62例患者的71处脊柱转移瘤接受了SIB-SBRT治疗。我们回顾性分析了SIB-SBRT后的毒性、局部肿瘤控制（LC）、无进展生存期（PFS）和总生存期（OS），并评估了可能的影响因素（Kaplan-Meier估计法、对数秩检验和Cox比例风险模型）。(3) 结果：SIB-SBRT分5次进行，多数采用25/40 Gy（n = 43；60.56%）和25/35 Gy（n = 19，26.76%）。1/2年时估计的无椎体压缩性骨折（VCF）发生率分别为96.1%/90.4%。VCF的发生与骨质疏松显著相关（P < 0.001）。未观察到≥III级急性毒性反应，仅1例III级晚期毒性反应（VCF）。1/2年时估计的LC率分别为98.6%/96.4%，组织学类型与局部治疗失败显著相关（P = 0.039）。中位PFS/OS为10个月（95%CI 6.01-13.99）/未达到。初次诊断后≥1年出现转移以及卡氏功能状态评分≥90%分别是PFS（P = 0.038）和OS（P = 0.012）较好的预测因素。(4) 结论：脊柱SIB-SBRT毒性低且局部控制良好。可用于特定的寡转移患者以改善预后。据我们所知，我们提供了更大患者队列中SIB-SBRT治疗脊柱转移瘤的毒性和有效性的首批临床数据。
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